Provider Demographics
NPI:1316932353
Name:CASEY, JEFFERY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ALLEN
Last Name:CASEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 EDWARDS PL SW
Mailing Address - Street 2:APT A
Mailing Address - City:BOLLING AFB
Mailing Address - State:DC
Mailing Address - Zip Code:20032-7353
Mailing Address - Country:US
Mailing Address - Phone:202-767-4150
Mailing Address - Fax:202-404-7366
Practice Address - Street 1:3905 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:HINDSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72738
Practice Address - Country:US
Practice Address - Phone:479-750-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice